Fixation system, an intramedullary fixation assembly and method of use

ABSTRACT

A fixation system, including an intramedullary fixation assembly and an instrument for coupling the intramedullary fixation assembly to bones. The intramedullary fixation assembly includes a proximal screw member positioned at a proximal end of the intramedullary fixation assembly, a distal member positioned at a distal end of the intramedullary fixation assembly, where the proximal screw member is slideably coupled to the distal member and makes a fixed angle with the distal member.

CROSS-REFERENCE TO RELATED APPLICATION

This application claims the benefit of Provisional Application No. 61/132,932, filed Jun. 24, 2008, the entire contents of which are herein incorporated by reference.

FIELD OF THE INVENTION

This invention relates to the field of orthopedic implant devices, and more particularly, to an intramedullary fixation assembly used for internal fixation of angled joints, bones and deformity correction, such as the bones in the foot.

BACKGROUND OF THE INVENTION

Orthopedic implant devices, such as intramedullary nails, plates, rods and screws are often used to repair or reconstruct bones and joints affected by trauma, degeneration, deformity and disease, such as Charcot arthropathy caused by diabetes in some patients. Charcot arthropathy (or Charcot foot) is a destructive process affecting many regions including joints of the foot and ankle in diabetics. This condition causes bony fragmentation, dislocation, and fractures that eventually progresses to foot deformity, bony prominences, ulceration and instability of the foot. Charcot arthropathy can affect any joint in the body but is often seen in the feet affecting the metatarsal, tarsometatarsal and tarsal joints and frequently causes the foot to lose its arch or curvature, thus resulting in “flat footedness” in the mid-foot region.

Early treatment for Charcot foot includes the use of therapeutic footwear, immobilization of the foot and/or non-weight bearing treatment. Surgical treatments include orthopedic fixation devices that fixate the bones in order to fuse them into a stable mass. These orthopedic implant devices realign bone segments and hold them together in compression until healing occurs, resulting in a stable mass.

Various implants have been utilized for surgical treatment, including bone screws. While these devices allow fixation and promote fusion, they do not deliver restoration of the arch in a

Charcot foot. Instead, the physician must estimate the arch and manually align the bones and deliver the screws to hold the bones in place, while reducing bone purchase. Intramedullary nails and/or a plate with a lag screw too have deficiencies. These intramedullary nails also do not reconstruct an arch that is lost due to Charcot foot disease.

Moreover, infections and wound complications are a major concern in aforementioned procedures. Wound closure is technically demanding for the surgeon, and devices that add surface prominence, such as plates or exposed screws, add to the difficulty by requiring greater tissue tension during incision reapproximation. This increases the risk of postoperative wound infections and dehiscence that may ultimately result in limb amputation.

There is therefore a need for an intramedullary fixation assembly and method of use that overcomes some or all of the previously delineated drawbacks of prior fixation assemblies.

SUMMARY OF THE INVENTION

An object of the present invention is to overcome the drawbacks of previous inventions.

Another object of the present invention is to provide a novel and useful intramedullary fixation assembly that may be utilized to treat any bones in human body.

Another object of the present invention is to provide a novel and useful intramedullary fixation assembly that may be utilized to treat bones in a mid-foot region.

Another object of the present invention is to restore the arch by utilizing an intramedullary assembly.

Another object of the present invention is to provide a system for treating deteriorating bones in a mid-foot region.

Another object of the present invention is to provide a method for restoring the arch of the foot by delivering a fixator that can be coupled in a patient's foot.

In a first non-limiting aspect of the present invention, a fixation assembly comprising two members is provided. A first member, positioned at a proximal end of the fixation assembly, has an elongated portion and a tapered bulbous end. A second member, positioned at a distal end of the fixation assembly, has an internal tapered aperture, wherein the elongated portion resides within the internal tapered aperture. The first member forms a fixed angle with the second member, thereby selectively coupling the first member to the second member.

In a second non-limiting aspect of the present invention, a method for reconstructing an arch in a mid-foot region comprises eight steps. Step one includes making an incision in the mid-foot region of a patient's foot. Step two includes gunstocking the foot to expose the articular surface. Step three includes reaming the intramedullary canal and inserting a distal member. Step four includes coupling the instrument to the distal member. Step five includes assessing the position of the proximal member with a guide wire. Step six includes pre-drilling a hole through the joints selected for fusion. The seventh step includes inserting the proximal member over the guide wire until rigid connection with the tapered aperture is made that compresses the joint and wherein the proximal member is at an angle to the distal member. The eighth step includes removing the instrument and closing the incision, thereby causing the arch to be formed in the mid-foot region.

In a third non-limiting aspect of the present invention, an instrument is combined with a fixation assembly for reconstructing an arch in a mid-foot region. The instrument has a handle, a “U-shaped” recess having two sides and a tapered bore. The intramedullary fixation assembly has a first member and a second member. The first member is positioned at a proximal end of the intramedullary fixation assembly. The first member has an elongated portion and a bulbous portion. The second member is positioned at a distal end of the intramedullary fixation assembly. The second member has an internal tapered aperture, a plurality of grooves and a threaded portion. The elongated portion resides within the internal tapered aperture, and a “U-shaped” recess having two sides that couple the first member to the second member, and further coupling the instrument to the intramedullary fixation assembly for reconstructing the arch in the mid-foot region.

BRIEF DESCRIPTION OF THE DRAWINGS

A further understanding of the present invention can be obtained by reference to a preferred embodiment set forth in the illustrations of the accompanying drawings. Although the illustrated embodiment is merely exemplary of systems and methods for carrying out the present invention, both the organization and method of operation of the invention, in general, together with further objectives and advantages thereof, may be more easily understood by reference to the drawings and the following description. The drawings are not intended to limit the scope of this invention, which is set forth with particularity in the claims as appended or as subsequently amended, but merely to clarify and exemplify the invention.

For a more complete understanding of the present invention, reference is now made to the following drawings in which:

FIG. 1 is a perspective view of a fixation system according to a preferred embodiment of the present invention.

FIG. 2 is a perspective view of a proximal screw member used in the fixation system shown in FIG. 1 according to the preferred embodiment of the present invention.

FIG. 3A is a perspective view of a distal member used in the fixation system shown in FIG. 1 according to the preferred embodiment of the present invention.

FIG. 3B is a perspective cross-sectional view of the distal member shown in FIG. 3A according to the preferred embodiment of the invention.

FIG. 4 is a perspective view of the instrument member used in the fixation system shown in FIG. 1 according to the preferred embodiment of the present invention.

FIG. 5 is a perspective view of the assembled intramedullary fixation assembly inserted into the bones of a patient's foot according to the preferred embodiment of the present invention.

FIG. 6 is a side view of the assembled intramedullary fixation assembly shown in FIG. 5 according to the preferred embodiment of the present invention.

FIG. 7 is a flow chart illustrating the method of coupling the intramedullary fixation assembly shown in FIGS. 1-6 to tarsal and metatarsal bones in a patient's foot according to the preferred embodiment of the present invention.

DETAILED DESCRIPTION

The present invention may be understood more readily by reference to the following detailed description of preferred embodiment of the invention. However, techniques, systems and operating structures in accordance with the present invention may be embodied in a wide variety of forms and modes, some of which may be quite different from those in the disclosed embodiment. Consequently, the specific structural and functional details disclosed herein are merely representative, yet in that regard, they are deemed to afford the best embodiment for purposes of disclosure and to provide a basis for the claims herein, which define the scope of the present invention. It must be noted that, as used in the specification and the appended claims, the singular forms “a”, “an”, and “the” include plural referents unless the context clearly indicates otherwise.

Referring now to FIG. 1, there is shown a fixation system 100 which is made in accordance with the teachings of the preferred embodiment of the invention. As shown, the fixation system 100 includes an intramedullary fixation assembly 110, comprising a proximal ‘screw member 130 and a distal member 140. Proximal screw member 130 is provided on proximal end 135 of assembly 110 and is coupled to a distal member 140 that is provided on the distal end 145 of the fixation assembly 110. Also, proximal screw member 130 makes a fixed angle 150 with distal member 140 and this angle 150 determines the angle for arch restoration. Moreover, fixation system 100 includes instrument 120 that is utilized to couple intramedullary fixation assembly 110 to the bones, in one non-limiting example, in the mid-foot region (not shown). It should be appreciated that in one non-limiting embodiment, intramedullary fixation assembly 110 may be made from a Titanium material, although, in other non-limiting embodiments, intramedullary fixation assembly 110 may be made from SST; PEEK, NiTi, Cobalt chrome or other similar types of materials. It should also be appreciated that intramedullary fixation assembly 110 may be utilized for the internal fixation of other bones in the human body.

As shown in FIG. 2, proximal screw member 130 is generally cylindrical in shape and extends from first bulbous portion 202 to second tapered end 204. End 204 has a diameter that is slightly smaller than diameter 226 of bulbous portion 202. Additionally, bulbous portion 202 has a taper, such as a Morse taper, with a width that decreases from end 211 to end 212. The taper allows for a locked interference fit with tapered aperture 316 when tapered bulbous portion 202 is combined with tapered aperture 316, shown and described below. Moreover, bulbous portion 202 is generally circular and has a generally hexagonal torque transmitting aperture 208 that traverses length 210 of bulbous portion 202. However, a star-shaped aperture, a square-shaped aperture, or any other shaped aperture may be utilized without departing from the scope of the present invention. Torque transmitting aperture 208 is utilized to transmit a torque from bulbous portion 202 to tapered end 204 by rotating bulbous portion 202.

Further, proximal screw member 130 has a first smooth exterior portion 206 extending from end 212 of bulbous portion 202. Portion 206 comprises an internal aperture 214 that longitudinally traverses portion 206 in direction 201. Portion 206 terminates into a second generally tubular portion 216. Portion 216 may comprise internal circular aperture 220 that longitudinally traverses inside portion 216. Internal circular aperture 220 is aligned with apertures 214 and 208 along axis 203 to form a continuous opening (i.e., a cannula) from bulbous portion 202 to end 204. The continuous opening or cannula is provided to interact with a guide wire (not shown) by receiving the guide wire within the continuous opening thereby positioning and locating the proximal member 130. In other non-limiting embodiments, the proximal member 130 may be provided without apertures 220 and 214 (i.e., the proximal member is solid).

Furthermore, tubular portion 216 has a plurality of circular threads, such as threads 218, which are circumferentially disposed on the external surface of portion 216 and, with threads 218 having an external diameter 224. Portion 216 may also be provided with a self-tapping leading edge 222 to provide portion 216 with the ability to remove bone material during insertion of proximal screw member 130 into bone. It should be appreciated that the length of the proximal member 130 may be selected of varying lengths to allow a surgeon to fuse different joints in a foot (not shown).

As shown in FIGS. 3A-3B, distal member 140 of the preferred embodiment is generally tubular in shape and tapers from a first end 302 to a second end 304 (i.e. end 302 has a diameter 306 that is slightly larger than diameter 308 of end 304). However, in another non-limiting embodiment, distal. member 140 has a constant width from first end 302 to second end 304. Further, first end 302 is generally semi-spherical in shape and has an internal circular aperture 316, which traverses end 302 along direction 301 (i.e. end 302 is generally “donut” shaped). Additionally, circular aperture 316 emanates from surface 322, such that portion 310 has a generally tapered aperture 316 provided in portion 310. Circular aperture 316 comprises slope 320 from first end 302 to end 322 of portion 310. Further, aperture 316 is aligned along axis 303, which is offset from horizontal axis 305 of distal member 140. Axis 303 forms an angle 150 with horizontal axis 305 that determines the angle for arch restoration, as shown in FIG. 3A. Angle 150 may be any angle greater than 90 degrees and less than 180 degrees. Tapered aperture 316 when combined with tapered bulbous portion 202, shown in FIG. 2, creates a locked interference fit between proximal member 130 and distal member 140. First end 302 has a plurality of substantially similar grooves 326 and 328, which form an “L-shape” with surface 330 of end 302. Grooves 326 and 328 are provided to receive instrument 120 of fixation system 100, which is later described. In other non-limiting embodiments, other similar instruments may be provided to be received within grooves 326 and 328.

Distal member 140 further comprises a generally smooth portion 310 coupled to end 302. Portion 310 has a generally hexagonal shaped aperture 312, which opens into aperture 316 and which longitudinally traverses through portion 310 in direction 301. In other non-limiting embodiments, a star-shaped aperture, a square-shaped aperture, or any other shaped aperture may be utilized. Circular aperture 316 has a diameter 314 that is slightly larger than external diameter 224 of portion 216 and 206 of proximal screw member 130, with portions 216 and 206 being slidably received within aperture 316 of portion 310. Aperture 316 has a diameter that is smaller than diameter 226 of bulbous -portion 202.

Portion 310 of distal member 140 terminates into a second generally cylindrical portion 318 which has a plurality of threads 324, which are circumferentially disposed on the external surface of portion 318. Portion 318 has an internal circular aperture 326 which is longitudinally coextensive with portion 318 in direction 301. Circular aperture 326 aligns with aperture 312 to form a continuous opening from end 302 to end 304.

As shown in FIG. 4, instrument 120 is illustrated for coupling proximal screw member 130 to distal member 140. Particularly, instrument 120 includes a handle portion 402 coupled to a rod portion 404. Rod portion 404 emanates from handle portion 402 at end 406 and terminates into a rectangular planar portion 408 at end 410. Planar portion 408 is aligned along axis 401 and is fixably coupled to a generally cylindrical tubular portion 412 (i.e., an aiming device). Portion 412 traverses portion 408 from top surface 414 to bottom surface 416. Further, tubular portion 412 is aligned along dissimilar axis 403, forming an angle 405 with axis 401. Also, tubular portion 412 has a through aperture 420 that longitudinally traverses portion 412 along axis 403.

Planar portion 408 is coupled to planar portion 422, with portion 422 having a width slightly smaller than width of portion 408. Portion 422 terminates into a generally “U-shaped” portion 424 with portion 424 being orthogonal to portion 422. Further, portion 424 has a plurality of substantially similar sides 426 and 428 which are provided to be slidably coupled to grooves 326 and 328 of distal member 140.

In operation, sides 426 and 428 of instrument 120 are received in respective grooves 326 and 328 of distal member 140, of FIGS. 3A-3B, thereby slidably coupling distal member 140 to instrument 120. In this position, axis 303 of aperture 316 is aligned along substantially the same axis as axis 403 of instrument 120. Proximal screw member 130 is coupled to distal member 140 by slidably coupling portions 206 and 216 through aperture 420 of tubular portion 412. Tubular portion 412 guides proximal screw member 130 through internal aperture 420 and into aperture 316 on surface 322 and may also guide a Kirschner wire (K wire) or a drill. Proximal screw member 130, of FIG. 2, travels into bone as portions 216 and 206 travel further through aperture 316 at end 302 until bulbous portion 202 is restrained by surface 322 and end 302. Aperture 316, being tapered along axis 303, causes proximal screw member 130 to form an angle 150 with distal member 140, with proximal member 130 being aligned along an axis 303, which is substantially the same axis as axis 403 of tubular portion 412 of instrument 120.

In operation, and as best shown in FIGS. 5, 6 and 7, the fixation system 100 utilizes the intramedullary fixation assembly 110 for treating and fixating the deteriorated and damaged or fractured bones in the human foot 500. This restores the arch in a human foot 500 by coupling the intramedullary fixation assembly 110 to the human foot 500 of a left leg. In one-non limiting example, and as shown in FIG. 5, the intramedullary assembly 110 is coupled to the medullary canals of the first metatarsal 502, medial cuneiform 504, navicular 506 and talus bone 508. Talus bone 508 makes up part of the ankle joint where the threaded portion 216 of the proximal screw member 130 of the intramedullary assembly 110 is threadably coupled. The medial cuneiform 504 and navicular 506 bones are most affected by Diabetic Charcot foot disorder that causes deterioration and collapse of the arch of the foot 500. It should be appreciated that the intramedullary assembly 110 may be used within each of the five rays, with a ray representing a line drawn from each metatarsal bone to the talus. The angulation in the smaller rays will be smaller than the two rays (i.e., a line from the first and second metatarsal bones to the talus bone). Also, the diameter of distal member 140 will decrease from the large ray to the small ray. In one non-limiting example, the angulation may be any angle greater than 90 degrees and less than 180 degrees. For example, the angle for the first ray may be 150-170 degrees and the angles for the other rays may be 160-175 degrees.

As shown in FIGS. 6 and 7, the intramedullary fixation assembly 110 may be utilized to reconstruct an arch in a mid-foot region of a human foot 500. As shown, the method starts in step 700 and proceeds to step 702, whereby a Dorsal Lis Franc incision (i.e., mid-foot incision) (not shown) is made in foot 500 in order to gain access to the joint. In step 704, the joint capsule is separated by “Gunstocking” foot 500 in direction 601 (i.e., the foot 500 is bent mid-foot) to expose the articular surface 602 and the articulating cartilage is removed. Next, in step 706, the intramedullary canal is reamed and the distal member 140 is inserted into the intramedullary canal (not shown) of the metatarsal 502. In other non-limiting embodiments, the distal member 140 may be inserted by impaction, by press fit, by reaming a hole in the intramedullary canal (not shown) or substantially any other similar strategy or technique. Next, in step 708, the instrument 120 is coupled to the distal member 140 by coupling sides 426 and 428 of instrument 120 to respective grooves 326 and 328. In step 710, initial positioning of the proximal member 130 is assessed with the use of a guide wire through portion 412 (i.e., aiming device). Next, in step 712, a countersink drill is inserted through portion 412 and the proximal cortex is penetrated. In this step, a cannulated drill or guide wire is used to pre-drill the hole through the joints selected for fusion. In step 714, the proximal screw member 130 is inserted over the guide wire and into the distal member 140. Particularly, the proximal member 130 is inserted through tubular portion 412 (i.e., aiming device), causing proximal member 130 to travel through internal longitudinal aperture 420, into distal member 140 and further into bones 504, 506 and 508 until rigid connection with the tapered aperture 316 is made, thereby compressing the joint. In one non-limiting embodiment, a locking element (not shown) such as a plate or a washer is coupled to end 302 of the intramedullary fixation assembly 110 to further secure proximal threaded member 130 to distal member 140. Next, in step 716 the instrument 120 is removed and the dorsal Lis Franc (i.e., mid-foot) incision is closed. The method ends in step 718.

It should be appreciated that a plurality of intramedullary fixation assemblies, such as intramedullary fixation assembly 110, may be inserted into any of the bones of a foot 500 such as, but not limited to the metatarsal, cuneiform, calcaneus, cuboid, talus and navicular bones, in order to restore the natural anatomical shape of the arch of the foot 500. Thus, the fixation system 100, in one non-limiting embodiment, is utilized to couple the intramedullary fixation assembly 110 to the foot 500, which causes the metatarsal 504, medial cuneiform 504, navicular 506 and talus 508 bones to be aligned to the proper anatomical shape of an arch when assembled within foot 500. It should be appreciated that the intramedullary fixation assembly 110 is delivered through a dorsal midfoot incision, thereby reducing the disruption to the plantar tissues and/or the metatarsal heads while at the same time minimizing the tension on the skin. This allows for improved wound closure, reduced operating room time, reduction in the number of incisions required and reduction in the total length of incisions. It should also be appreciated that in other non-limiting embodiments, the intramedullary assembly 110 may be utilized with graft material (i.e., autograft, allograft or other biologic agent).

It should be understood that this invention is not limited to the disclosed features and other similar method and system may be utilized without departing from the spirit and the scope of the present invention.

While the present invention has been described with reference to the preferred embodiment and alternative embodiments, which embodiments have been set forth in considerable detail for the purposes of making a complete disclosure of the invention, such embodiments are merely exemplary and are not intended to be limiting or represent an exhaustive enumeration of all aspects of the invention. The scope of the invention, therefore, shall be defined solely by the following claims. Further, it will be apparent to those of skill in the art that numerous changes may be made in such details without departing from the spirit and the principles of the invention. It should be appreciated that the present invention is capable of being embodied in other forms without departing from its essential characteristics. 

1. An intramedullary fixation assembly for bone fusion, comprising: a proximal screw member positioned at a proximal end of the intramedullary fixation assembly; and a distal member positioned at a distal end of the intramedullary fixation assembly, wherein the proximal screw member is slideably coupled to the distal member and makes a fixed angle with the distal member.
 2. The intramedullary fixation assembly of claim 1, wherein the proximal screw member comprises a first elongated body, wherein the first elongated body includes a first threaded portion at a first end and a bulbous portion at a second end.
 3. The intramedullary fixation assembly of claim 2, wherein the bulbous portion includes a taper for providing an interference fit with the distal member.
 4. The intramedullary fixation assembly of claim 3, wherein the taper provides for an interference lock with the distal member.
 5. The intramedullary fixation assembly of claim 4, wherein the proximal screw member is cannulated having a circular cross-section with the first elongated body.
 6. The intramedullary fixation assembly of claim 5, wherein the bulbous portion further includes an orifice longitudinally coextensive with a length of the bulbous portion.
 7. The intramedullary fixation assembly of claim 6, wherein the orifice has a hexagonal shape, a star shape, or a square shape.
 8. The intramedullary fixation assembly of claim 7, wherein the orifice is provided to receive a complementary shaped end of an instrument.
 9. The intramedullary fixation assembly of claim 8, wherein the first threaded portion contains a plurality of bone threads on an outer surface of the threaded portion.
 10. The intramedullary fixation assembly of claim 9, wherein the first threaded portion includes a self-tapping edge, wherein the self-tapping edge provides for removal of bone material during insertion of the proximal screw member.
 11. The intramedullary fixation assembly of claim 10, wherein the distal member further includes a second elongated body, wherein the second elongated body contains a second threaded portion at a third end, and an opening at a fourth end.
 12. The intramedullary fixation assembly of claim 11, wherein the distal member further includes a plurality of first and second grooves for coupling to an instrument, wherein the plurality of first and second grooves are disposed at the opening at the fourth end.
 13. The intramedullary fixation assembly of claim 12, wherein the distal member further comprises a plurality of apertures disposed in the second elongated body.
 14. The intramedullary fixation assembly of claim 13, wherein the plurality of apertures includes a first internal aperture and a tapered internal aperture.
 15. The intramedullary fixation assembly of claim 14, wherein the first internal aperture longitudinally traverses the second elongated body from the third end to the fourth end.
 16. The intramedullary fixation assembly of claim 15, wherein the first internal aperture further includes a hexagonally shaped opening, a star-shaped opening, or a square-shaped opening partially disposed in the second elongated body.
 17. The intramedullary fixation assembly of claim 16, wherein the opening is provided to receive a complementary shaped member.
 18. The intramedullary fixation assembly of claim 17, wherein the internal tapered aperture traverses the second elongated body from the fourth end to an exterior surface on the second elongated body.
 19. The intramedullary fixation assembly of claim 18, wherein the first internal aperture is provided to receive the first elongated body of the proximal screw member, wherein the bulbous portion is contained in the first internal aperture, and further wherein the bulbous portion abuts the opening at the fourth end.
 20. The intramedullary fixation assembly of claim 19, wherein the first threaded portion is at an opposite end to the second threaded portion in the intramedullary fixation assembly.
 21. The intramedullary fixation assembly of claim 20, wherein the internal tapered aperture forms a predetermined angle with the first internal aperture.
 22. The intramedullary fixation assembly of claim 21, wherein the predetermined angle determines the angle for arch restoration.
 23. The intramedullary fixation assembly of claim 22, wherein the second threaded portion contains a plurality of threads on an outer surface of the second threaded portion.
 24. The intramedullary fixation assembly of claim 23, wherein the second threaded portion includes a self-tapping edge, ‘wherein the self-tapping edge provides for removal of bone material during insertion of the distal screw member.
 25. The intramedullary fixation assembly of claim 24, wherein the proximal screw member is provided for insertion into a first medullary canal of a first bone.
 26. The intramedullary fixation assembly of claim 25, wherein the distal member is provided for insertion into a second medullary canal of a second bone.
 27. The intramedullary fixation assembly of claim 26, wherein the predetermined angle is between 0 to 180 degrees.
 28. A method for bone fusion, comprising: providing an intramedullary fixation assembly, wherein the intramedullary fixation assembly further comprises: a proximal screw member positioned at a proximal end of the intramedullary fixation assembly; and a distal member positioned at a distal end of the intramedullary fixation assembly, wherein the proximal screw member is slideably coupled to the distal member and makes a fixed angle with the distal member; drilling a first medullary canal in a first bone and drilling a second medullary canal in a second bone; inserting the distal member into the first medullary canal; coupling the instrument to the distal member; slideably coupling the proximal screw member to the distal member; inserting the proximal screw member into the second medullary canal; applying compression to the proximal screw member to lock the distal member to the proximal screw member, thereby fusing the first bone to the second bone.
 29. The method of claim 28, wherein the proximal screw member comprises a first elongated body, wherein the first elongated body includes a first threaded portion at a first end and a bulbous portion at a second end.
 30. The method of claim 29, wherein the bulbous portion includes a locking mechanism for providing an interference fit with the distal member.
 31. The method of claim 30, wherein the locking mechanism provides for an interference lock with the distal member.
 32. The method of claim 31, wherein the locking mechanism includes a morse taper for providing an interference lock with the distal member.
 33. The method of claim 32, wherein the proximal screw member is cannulated having a circular cross-section with the first elongated body.
 34. The method of claim 33, wherein the bulbous portion further includes an orifice longitudinally coextensive with a length of the bulbous portion.
 35. The method of claim 34, wherein the orifice has a hexagonal shape, a star shape, or a square shape.
 36. The method of claim 35, wherein the orifice is provided to receive a complementary shaped end of an instrument.
 37. The method of claim 36, wherein the first threaded portion contains a plurality of bone threads on an outer surface of the threaded portion.
 38. The method of claim 37, wherein the first threaded portion includes a self-tapping edge, wherein the self-tapping edge provides for removal of bone material during insertion of the proximal screw member.
 39. The method of claim 38, wherein the distal member further includes a second elongated body, wherein the second elongated body contains a second threaded portion at a third end, and an opening at a fourth end.
 40. The method of claim 39, wherein the distal member further includes a plurality of first and second grooves for coupling to the instrument, wherein the plurality of first and second grooves are disposed at the opening at the fourth end.
 41. The method of claim 40, wherein the distal member further comprises a plurality of apertures disposed in the second elongated body.
 42. The method of claim 41, wherein the plurality of apertures includes a first internal aperture and a tapered internal aperture.
 43. The method of claim 42, wherein the first internal aperture longitudinally traverses the second elongated body from the third end to the fourth end.
 44. The method of claim 43, wherein the first internal aperture further includes a hexagonally shaped opening, a star-shaped opening, or a square-shaped opening partially disposed in the second elongated body.
 45. The method of claim 44, wherein the opening is provided to receive a complementary shaped member.
 46. The method of claim 45, wherein the internal tapered aperture traverses the second elongated body from the fourth end to an exterior surface on the second elongated body.
 47. The method of claim 46, wherein the first internal aperture is provided to receive the first elongated body of the proximal screw member, wherein the bulbous portion is contained in the first internal aperture, and further wherein the bulbous portion abuts the opening at the fourth end.
 48. The method of claim 47, wherein the first threaded portion is at an opposite end to the second threaded portion in the intramedullary fixation assembly.
 49. The method of claim 48, wherein the internal tapered aperture forms a predetermined angle with the first internal aperture.
 50. The method of claim 49, wherein the predetermined angle determines the angle for arch restoration.
 51. The method of claim 50, wherein the predetermined angle is between 0 and 180 degrees.
 52. The method of claim 51, wherein the second threaded portion contains a plurality of threads on an outer surface of the second threaded portion.
 53. The method of claim 52, wherein the second threaded portion includes a self-tapping edge, wherein the self-tapping edge provides for removal of bone material during insertion of the distal screw member.
 54. The method of claim 53, wherein the first medullary canal is located in a metatarsal bone in the human foot.
 55. The Method of claim 54, wherein the second medullary canal is located in a cuneiform bone, a navicular bone, or a talus bone in the human foot.
 56. A fixation system, comprising: a proximal screw member positioned at a proximal end of the intramedullary fixation assembly; a distal member positioned at a distal end of the intramedullary fixation assembly, wherein the proximal screw member is slideably coupled to the distal member and makes a fixed angle with the distal member.
 57. The fixation system of claim 56, wherein the proximal screw member comprises a first elongated body, wherein the first elongated body includes a first threaded portion at a first end and a bulbous portion at a second end.
 58. The fixation system of claim 57, wherein the bulbous portion includes a locking mechanism for providing an interference fit with the distal member.
 59. The fixation system of claim 58, wherein the locking mechanism provides for an interference lock with the distal member.
 60. The fixation system of claim 59, wherein the locking mechanism includes a morse taper for providing an interference lock with the distal member.
 61. The fixation system of claim 60, wherein the proximal screw member is cannulated having a circular cross-section with the first elongated body.
 62. The fixation system of claim 61, wherein the bulbous portion further includes an orifice longitudinally coextensive with a length of the bulbous portion.
 63. The fixation system of claim 62, wherein the orifice has a hexagonal shape, a star shape, or a square shape.
 64. The fixation system of claim 63, wherein the orifice is provided to receive a complementary shaped end of a member.
 65. The fixation system of claim 63, wherein the first threaded portion contains a plurality of bone threads on an outer surface of the threaded portion.
 66. The fixation system of claim 65, wherein the first threaded portion includes a self-tapping edge, wherein the self-tapping edge provides for removal of bone material during insertion of the proximal screw member.
 67. The fixation system of claim 66, wherein the distal member further includes a second elongated body, wherein the second elongated body contains a second threaded portion at a third end, and an opening at a fourth end.
 68. The fixation system of claim 67, wherein the distal member further includes a plurality of first and second grooves, wherein the plurality of first and second grooves are disposed at the opening at the fourth end.
 69. The fixation system of claim 68, wherein the distal member further comprises a plurality of apertures disposed in the second elongated body.
 70. The fixation system of claim 69, wherein the plurality of apertures includes a first internal aperture and a tapered internal aperture.
 71. The fixation system of claim 70, wherein the first internal aperture longitudinally traverses the second elongated body from the third end to the fourth end.
 72. The fixation system of claim 71, wherein the first internal aperture further includes a hexagonally shaped opening, a star-shaped opening, or a square-shaped opening partially disposed in the second elongated body.
 73. The fixation system of claim 72, wherein the opening is provided to receive a complementary shaped member.
 74. The fixation system of claim 73, wherein the internal tapered aperture traverses the second elongated body from the fourth end to an exterior surface on the second elongated body.
 75. The fixation system of claim 74, wherein the first internal aperture is provided to receive the first elongated body of the proximal screw member, wherein the bulbous portion is contained in the first internal aperture, and further wherein the bulbous portion abuts the opening at the fourth end.
 76. The fixation system of claim 75, wherein the first threaded portion is at an opposite end to the second threaded portion in the intramedullary fixation assembly.
 77. The fixation system of claim 76, wherein the internal tapered aperture forms a predetermined angle with the first internal aperture.
 78. The fixation system of claim 77, wherein the predetermined angle determines the angle for arch restoration.
 79. The fixation system of claim 78, wherein the predetermined angle is between 0 and 180 degrees.
 80. The fixation system of claim 79, wherein the second threaded portion contains a plurality of threads on an outer surface of the second threaded portion.
 81. The fixation system of claim 80, wherein the second threaded portion includes a self-tapping edge, wherein the self-tapping edge provides for removal of bone material during insertion of the distal screw member.
 82. The fixation system of claim 81, wherein the proximal screw member is provided for insertion into a first medullary -canal of a first bone.
 83. The fixation system of claim 82, wherein the distal member is provided for insertion into a second medullary canal of a second bone.
 84. The fixation system of claim 83, wherein the first medullary canal is located in a cuneiform bone, a navicular bone, or a talus bone in the human foot.
 85. The fixation system of claim 84, wherein the second medullary canal is located in a metatarsal bone in the human foot.
 86. An intramedullary fixation, assembly for metatarsal bone fusion in a human foot, comprising: a proximal screw member for coupling to a cuneiform bone, a navicular bone, or a talus bone, wherein the proximal screw member is positioned at a proximal end of the intramedullary fixation assembly; and a distal member for connecting to a metatarsal bone, wherein the distal member is positioned at a distal end of the intramedullary fixation assembly, wherein the proximal screw member is slideably coupled to the distal member and makes a fixed angle with the distal member.
 87. The intramedullary fixation assembly of claim 86, wherein the proximal screw member comprises a first elongated body, wherein the first elongated body includes a first threaded portion at a first end and a bulbous portion at a second end.
 88. The intramedullary fixation assembly of claim 87, wherein the bulbous portion includes a locking mechanism for providing an interference fit with the distal member.
 89. The intramedullary fixation assembly of claim 88, wherein the locking mechanism provides for an interference lock with the distal member.
 90. The intramedullary fixation assembly of claim 89, wherein the locking mechanism includes a morse taper.
 91. The intramedullary fixation assembly of claim 90, wherein the proximal screw member is cannulated having a circular cross-section with the first elongated body.
 92. The intramedullary fixation assembly of claim 91, wherein the bulbous portion further includes an orifice longitudinally coextensive with a length of the bulbous portion.
 93. The intramedullary fixation assembly of claim 92, wherein the orifice has a hexagonal shape, a star shape, or a square shape.
 94. The intramedullary fixation assembly of claim 93, wherein the orifice is provided to receive a complementary shaped end of a member.
 95. The intramedullary fixation assembly of claim 93, wherein the first threaded portion contains a plurality of bone threads on an outer surface of the threaded portion.
 96. The intramedullary fixation assembly of claim 95, wherein the first threaded portion includes a self-tapping edge, wherein the self-tapping edge provides for removal of bone material during insertion of the proximal screw member.
 97. The intramedullary fixation assembly of claim 96, wherein the distal member further includes a second elongated body, wherein the second elongated body contains a second threaded portion at a third end, and an opening at a fourth end.
 98. The intramedullary fixation assembly of claim 97, wherein the distal member further includes a plurality of first and second grooves for coupling to an instrument, wherein the plurality of first and second grooves are disposed at the opening at the fourth end.
 99. The intramedullary fixation assembly of claim 98, wherein the distal member further comprises a plurality of apertures disposed in the second elongated body.
 100. The intramedullary fixation assembly of claim 99, wherein the plurality of apertures includes a first internal aperture and a tapered internal aperture.
 101. The intramedullary fixation assembly of claim 100, wherein the first internal aperture longitudinally traverses the second elongated body from the third end to the fourth end.
 102. The intramedullary fixation assembly of claim 101, wherein the first internal aperture further includes a hexagonally shaped opening, a star-shaped opening, or a square-shaped opening partially disposed in the second elongated body.
 103. The intramedullary fixation assembly of claim 102, wherein the opening is provided to receive a complementary shaped member.
 104. The intramedullary fixation assembly of claim 103 wherein the internal tapered aperture traverses the second elongated body from the fourth end to an exterior surface on the second elongated body.
 105. The intramedullary fixation assembly of claim 104, wherein the first internal aperture is provided to receive the first elongated body of the proximal screw member, wherein the bulbous portion is contained in the first internal aperture, and further wherein the bulbous portion abuts the opening at the fourth end.
 106. The intramedullary fixation assembly of claim 105, wherein the first threaded portion is at an opposite end to the second threaded portion in the intramedullary fixation assembly.
 107. The intramedullary fixation assembly of claim 106, wherein the internal tapered aperture forms a predetermined angle with the first internal aperture.
 108. The intramedullary fixation assembly of claim 107, wherein the predetermined angle determines the angle for arch restoration.
 109. The intramedullary fixation assembly of claim 108, wherein the predetermined angle is between 0 and 180 degrees.
 110. The intramedullary fixation assembly of claim 109, wherein the second threaded portion contains a plurality of threads on an outer surface of the second threaded portion.
 111. The intramedullary fixation assembly of claim 110, wherein the second threaded portion includes a self-tapping edge, wherein the self-tapping edge provides for removal of bone material during insertion of the distal screw member.
 112. The intramedullary fixation assembly of claim 111, wherein the proximal screw member is provided for insertion into a first medullary canal of a cuneiform bone, a navicular bone, or a talus bone.
 113. The intramedullary fixation assembly of claim 112, wherein the distal member is provided for insertion into a second medullary canal of a metatarsal bone. 